Schwangere mit Gestationsdiabetes in Berlin – Perinataldatenanalyse mit besonderer Berücksichtigung des Migrationsstatus

Zusammenfassung

Für Deutschland liegen bisher keine systematisch erhobenen Daten zur Betreuung von Migrantinnen mit Gestationsdiabetes (GDM) vor, obwohl die Anzahl von Migrantinnen in deutschen Geburtskliniken seit den 1980er Jahren kontinuierlich zunimmt.

Methodik Auf Grundlage der Fallzahlschätzung für diese prospektive Studie wurde der Einschluss von 160 GDM-Patientinnen+/- einer Drop-Out-Rate von 10 GDM-Patientinnen pro Gruppe, 90 mit Migrationshintergrund (MH) und 90 ohne MH, angestrebt. Die Datenerhebung erfolgte mittels Fragebogen zur Erhebung soziodemografischer Daten, Migration, Akkulturation und Ernährungsverhalten, sowie der Erfassung relevanter Perinataldaten (z. B. pränatales Schätzgewicht, Geburtsmodus, etc.) aus der peripartalen Betreuung.

Ergebnisse Zwischen Januar 2017 und Mai 2019 wurden 198 GDM-Patientinnen untersucht. Hiervon hatten 110 GDM-Patientinnen einen und 88 keinen MH. Die Indikation zur Geburtseinleitung aufgrund der Verdachtsdiagnose einer fetalen Makrosomie wurde ungefähr gleich häufig für die GDM-Patientinnen mit sowie ohne MH gestellt (mit MH 3,6% vs. ohne MH 4,6%, p=1,0, OR 1,73; 95%-KI 0,79–3,89, p=0,17). GDM-Patientinnen mit MH gebaren ihr Kind häufiger spontan (mit MH 55,5% vs. ohne MH 40,9%, p=0,05). Das perinatale Outcome war in beiden Gruppen vergleichbar.

Schlussfolgerungen Die Hypothese, dass bei GDM-Patientinnen mit MH häufiger Geburtseinleitungen aufgrund der Verdachtsdiagnose eines makrosomen Fetus erforderlich sind, wurde nicht bestätigt. Wesentliche neonatale Parameter wie Geburtsgewicht oder Verlegung der Neugeborenen waren ohne signifikante Unterschiede im Gruppenvergleich.

Abstract

To date there has not been a systematic analysis of pregnant patients with an immigrant background and gestational diabetes in Germany, even though the number of these patients has been rising continuously since the 1980s.

MethodsThe case number estimate for this prospective study targeted 160 patients with gestational diabetes with and without an immigrant background. A questionnaire on socio-economic status, immigrant background, acculturation, and food intake was developed. The birth parameters and pre- and postpartum parameters were regularly documented.

Results In our study we included 198 patients with gestational diabetes, consisting of 110 patients with an immigrant background and 88 patients without an immigrant background. The number of labor inductions for the suspected diagnosis of fetal macrosomia was almost the same in both groups (immigrant background 3.6% vs. without immigrant background 4.6%, p=1.0; OR 1.73; 95% CI; 0.79–3.89, p=0.17). The study patients with an immigrant background were more likely to give birth spontaneously than via cesarean section or vaginal-operative birth. The perinatal outcome of children from our study patients with and without an immigrant background were similar.

Conclusion We show that regardless of their immigrant background gestational diabetes patients have similar and homogeneous patient-centered care at our clinic.

Schlüsselwörter

Gestationsdiabetes - fetale Makrosomie - Geburtseinleitung - Migrationshintergrund - Perinatales Outcome

Key words

gestational diabetes - foetal macrosomia - labor induction - immigrant background - perinatal outcome

Publication History

Received: 04 July 2020

Accepted after revision: 13 September 2020

Article published online:
02 November 2020

• Literatur

• 1 Nankervis A, Conn J. Gestational diabetes mellitus−negotiating the confusion. Aust Fam Physician 2013; 42: 528-531
• 2 Schafer-Graf UM, Gembruch U, Kainer F. et al. Gestational Diabetes Mellitus (GDM) - Diagnosis, Treatment and Follow-Up. Guideline of the DDG and DGGG (S3 Level, AWMF Registry February 2018). Geburtshilfe Frauenheilkd 2018; 78: 1219-1231 DOI: 10.1055/a-0659-2596.
• 3 Krishnaveni GV, Veena SR, Hill JC. et al. Intrauterine exposure to maternal diabetes is associated with higher adiposity and insulin resistance and clustering of cardiovascular risk markers in Indian children. Diabetes Care 2010; 33: 402-404 DOI: 10.2337/dc09-1393.
• 4 Yuen L, Wong VW, Simmons D. Ethnic Disparities in Gestational Diabetes. Curr Diab Rep 2018; 18: 68 . doi:10.1007/s11892-018-1040-2
• 5 Wan CS, Abell S, Aroni R. et al. Ethnic differences in prevalence, risk factors, and perinatal outcomes of gestational diabetes mellitus: A comparison between immigrant ethnic Chinese women and Australian-born Caucasian women in Australia. J Diabetes 2019; 11: 809-817 DOI: 10.1111/1753-0407.12909.
• 6 Gagnon AJ, McDermott S, Rigol-Chachamovich J. et al. International migration and gestational diabetes mellitus: a systematic review of the literature and meta-analysis. Paediatr Perinat Epidemiol 2011; 25: 575-592 DOI: 10.1111/j.1365-3016.2011.01230.x.
• 7 Bundesamt S Migration und Integration: Personen mit Migrationshintergrund. https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bevoelkerung/Migration-Integration/Methoden/Erlauterungen/migrationshintergrund.html?nn=208952
• 8 Wang LF, Wang HJ, Ao D. et al. Influence of pre-pregnancy obesity on the development of macrosomia and large for gestational age in women with or without gestational diabetes mellitus in Chinese population. J Perinatol 2015; 35: 985-990 DOI: 10.1038/jp.2015.119.
• 9 Goel MS, McCarthy EP, Phillips RS. et al. Obesity among US immigrant subgroups by duration of residence. JAMA 2004; 292: 2860-2867 DOI: 10.1001/jama.292.23.2860.
• 10 Boshari T, Urquia ML, Sgro M. et al. Differences in birthweight curves between newborns of immigrant mothers vs. infants born in their corresponding native countries: systematic overview. Paediatr Perinat Epidemiol 2013; 27: 118-130 DOI: 10.1111/ppe.12038.
• 11 Reeske A, Spallek J, Bammann K. et al. Migrant background and weight gain in early infancy: results from the German study sample of the IDEFICS study. PLoS One 2013; 8: e60648 DOI: 10.1371/journal.pone.0060648.
• 12 Bollini P, Pampallona S, Wanner P. et al. Pregnancy outcome of migrant women and integration policy: a systematic review of the international literature. Soc Sci Med 2009; 68: 452-461 DOI: 10.1016/j.socscimed.2008.10.018.
• 13 Villalonga-Olives E, Adams I, Kawachi I. The development of a bridging social capital questionnaire for use in population health research. SSM Popul Health 2016; 2: 613-622 . doi:10.1016/j.ssmph.2016.08.008
• 14 Zolitschka KA, Miani C, Breckenkamp J. et al. Do social factors and country of origin contribute towards explaining a “Latina paradox” among immigrant women giving birth in Germany?. BMC Public Health 2019; 19: 181 DOI: 10.1186/s12889-019-6523-9.
• 15 Yuen L, Wong VW. Gestational diabetes mellitus: Challenges for different ethnic groups. World J Diabetes 2015; 6: 1024-1032 . doi:10.4239/wjd.v6.i8.1024
• 16 Carolan M, Steele C, Margetts H. Knowledge of gestational diabetes among a multi-ethnic cohort in Australia. Midwifery 2010; 26: 579-588 . doi:10.1016/j.midw.2009.01.006
• 17 Savitz DA, Janevic TM, Engel SM. et al. Ethnicity and gestational diabetes in New York City, 1995-2003. BJOG 2008; 115: 969-978 DOI: 10.1111/j.1471-0528.2008.01763.x.
• 18 David M, Borde T, Brenne S. et al. Obstetric and perinatal outcomes among immigrant and non-immigrant women in Berlin, Germany. Arch Gynecol Obstet 2017; 296: 745-762 DOI: 10.1007/s00404-017-4450-5.
• 19 Perez Rodrigo C, Aranceta J, Salvador G. et al. Food frequency questionnaires. Nutr Hosp 2015; 31: 49-56 DOI: 10.3305/nh.2015.31.sup3.8751.
• 20 Haftenberger M, Heuer T, Heidemann C. et al. Relative validation of a food frequency questionnaire for national health and nutrition monitoring. Nutr J 2010; 9: 36 DOI: 10.1186/1475-2891-9-36.
• 21 Araujo Junior E, Peixoto AB, Zamarian AC. et al. Macrosomia. Best Pract Res Clin Obstet Gynaecol 2017; 38: 83-96 DOI: 10.1016/j.bpobgyn.2016.08.003.
• 22 Kieffer EC, Martin JA, Herman WH. Impact of maternal nativity on the prevalence of diabetes during pregnancy among U.S. ethnic groups. Diabetes Care 1999; 22: 729-735 . doi:10.2337/diacare.22.5.729
• 23 von Katterfeld B, Li J, McNamara B. et al. Maternal and neonatal outcomes associated with gestational diabetes in women from culturally and linguistically diverse backgrounds in Western Australia. Diabet Med 2012; 29: 372-377 DOI: 10.1111/j.1464-5491.2011.03483.x.
• 24 De Curtis M, Villani L, Polo A. High risk of macrosomia in newborns of immigrant mothers. Ital J Pediatr 2020; 46: 8 . doi:10.1186/s13052-020-0771-2
• 25 Aulinas A, Biagetti B, Vinagre I. et al. Gestational diabetes mellitus and maternal ethnicity: high prevalence of fetal macrosomia in non-Caucasian women. Med Clin (Barc) 2013; 141: 240-245 DOI: 10.1016/j.medcli.2012.05.034.
• 26 Seghieri G, Cianni GD, Seghieri M. et al. Risk and adverse outcomes of gestational diabetes in migrants: A population cohort study. Diabetes Res Clin Pract 2020; 163: 108128 DOI: 10.1016/j.diabres.2020.108128.
• 27 Baird J, Fisher D, Lucas P. et al. Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ 2005; 331: 929 DOI: 10.1136/bmj.38586.411273.E0.
• 28 Hedderson M, Ehrlich S, Sridhar S. et al. Racial/ethnic disparities in the prevalence of gestational diabetes mellitus by BMI. Diabetes Care 2012; 35: 1492-1498 DOI: 10.2337/dc11-2267.
• 29 Urquia M, Glazier RH, Berger H. et al. Gestational diabetes among immigrant women. Epidemiology 2011; 22: 879-880 DOI: 10.1097/EDE.0b013e31823199ee.
• 30 Merry L, Small R, Blondel B. et al. International migration and caesarean birth: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2013; 13: 27 DOI: 10.1186/1471-2393-13-27.
• 31 Langford A, Joshu C, Chang JJ. et al. Does gestational weight gain affect the risk of adverse maternal and infant outcomes in overweight women?. Matern Child Health J 2011; 15: 860-865 DOI: 10.1007/s10995-008-0318-4.
• 32 Breckenkamp J, Razum O, Henrich W. et al. Effects of maternal obesity, excessive gestational weight gain and fetal macrosomia on the frequency of cesarean deliveries among migrant and non-migrant women – a prospective study. J Perinat Med 2019; 47: 402-408 DOI: 10.1515/jpm-2018-0399.